New DBT therapy program has taken off for counseling services

Category: Counseling News|Published on: Thursday, Jan. 6, 2011

The IPC began its first Dialectical Behavior Training (DBT) program in November 2010. The skills group filled up quickly and has had a long waitlist ever since. This therapy is not only popular, it is scientifically sound. In other words, it works.

Marsha Linehan, Ph.D. developed the cognitive-behavioral approach in the early 1990s. She is currently the Director of the Behavioral Research & Therapy Clinics (BRTC) and a professor at the University of Washington. Linehan’s work is primarily focused on the understanding, assessment and treatment of suicidal behaviors, drug addictions and Borderline Personality Disorder. The primary treatment under development at the BRTC is DBT.

DBT is a form of evidence-based treatment for severe and persistent emotional and behavioral difficulties. Marsha’s Linehan’s motto for DBT is to help people “create a life worth living” through weekly skills training and therapy.

Still, entering into DBT therapy isn’t easy; there are financial and insurance barriers to the treatment, for people who do not have insurance or the ability to pay for services on their own.

Pat Stankovitch, director of Psychological Services at the IPC, summed up the conflict between the need for and barrier to DBT services, “There are so many clients that can use (DBT) and very few resources available that are affordable for them.”

That’s where the IPC comes in. A key part of the center’s mission involves serving underserved populations and the under- and uninsured. The counseling services branch of the clinic also aims to provide the best therapy services available, said Robyn Maley, a third-year Psy.D. student in counseling psychology who also acts as the DBT skills group co-facilitator.

Maley saw firsthand the kind of positive effects DBT treatment could have when she led a DBT skills group during a traineeship at Scott County Mental Health Center during her 2009-2010 practicum. Through this experience, Maley saw the incredible need for this service as well as successful results from clients’ active and consistent participation in the skills group as well as regular attendance in individual therapy.

When the subject of Maley’s previous DBT experience came up during a supervision session with her supervisor, Pat Stankovitch, the fact that Robyn had facilitated a DBT skills group really excited Stankovitch. Stankovitch had experienced frustration in trying to find DBT services for several previous and current IPC clients. Stankovitch asked Maley if she would be willing to facilitate a group at the IPC which would allow DBT to become a new training opportunity for practicum and pre-doctoral internship students.

Stankovitch, a graduate of UST’s Psy.D. program, then thought of one of her doctoral cohort members, Dr. Beverly Long, who has worked with DBT clients for 20 years. Stankovitch knew Dr. Long would be an excellent resource for the IPC in developing a full-blown DBT program, incorporating all of Marsha Linehan’s evidence-based components. Thanks to Robyn Maley’s significant contribution of time and effort in developing the initial marketing materials and the complete intake process as well as Dr. Long’s dedication to training all IPC practitioners and sharing her immense expertise, the IPC’s DBT program is already being viewed as a valuable resource within the community.

“That’s the beauty of the IPC,” said Tessa Tuetken, a second-year Master’s of Social Work student and co-facilitator of the DBT skills group. Students can have areas of interest in which they can gain valuable experience during their training year at the IPC, she said.

The program consists of four components for clients: a weekly skills group where clients learn effective coping skills, weekly individual therapy sessions to help clients reduce their specific self-destructive behaviors and feel better able to solve daily problems, coaching calls when needed, and a consultation team for support for therapists and skills-group facilitators. Psychology and clinical social work students conduct individual therapy sessions and also attend the weekly consultation group meeting to receive support for their work and to fine tune their skills in providing DBT services.

The IPC is an appropriate place to offer DBT services because of the large population of clients with serious and persistent mental illness (SPMI) the clinic serves. Some of the clients meet criteria for illnesses such as Borderline Personality Disorder, Major Depressive Disorder and Bipolar Disorder.

A challenge in the group has been the large amount of no-shows and drop-outs. No shows and dropouts are not atypical for a clientele group that experiences many crises in their daily lives, said Tuetken. However, there is no shortage of people interested in the services as the lengthy waitlist proves.

Maley and Tuetken actively participate in the skills group with their clients. DBT values therapist disclosure to a degree that clients can relate to those leading the group. Because of this, a sense of “realness” prevails in group sessions, the co-facilitators agreed. Maley and Tuetken are able to use stories from their own lives to form connections with the group participants and to illustrate that everyone has struggles in life and needs skills to cope.

Clients and facilitators agree that DBT is a user-friendly approach. That is, it can be applicable for everyone and not just for those with serious mental illness.

“(Clients) wish everyone would learn it because it’s been so helpful,” Tuetken and Maley explained. “They’re learning it’s not just skills to use if you have SPMI; they point out that we (as facilitators) can use them too.”

In skills group each week, clients make realizations about their feelings and behaviors.

“A lot of lightbulbs go off,” said Tuetken, as clients make realizations that, for example, their anxiety is linked to fear.

Participants also learn about the biological and environmental influences of various illnesses. They also receive validation when they realize it is not their fault that they were not taught adequate skills to deal with hardships growing up.

The IPC/DBT connection is here to stay. Stankovitch is working with the MN Life College to start another skills group in the fall with graduates of their program who struggle with ADHD, learning disabilities and autism spectrum disorders. These young adults are navigating the transition of beginning to work and move into a more independent lifestyle. It is anticipated that the problems they face in terms of regulating difficult emotions and being in new interpersonal experiences will be helped by their learning DBT skills.